








key: cord-274845-pqvlh3eg
authors: Li, Yan; Wang, Jiangshan; Wang, Chunting; Yang, Qiwen; Xu, Yingchun; Xu, Jun; Li, Yi; Yu, Xuezhong; Zhu, Huadong; Liu, Jihai
title: Characteristics of respiratory virus infection during the outbreak of 2019 novel coronavirus in Beijing
date: 2020-05-07
journal: Int J Infect Dis
DOI: 10.1016/j.ijid.2020.05.008
sha: 
doc_id: 274845
cord_uid: pqvlh3eg

Abstract Background Coronavirus disease 2019 (COVID-19) is spreading. Here, we summarized the composition of pathogens in fever clinic patients and analyzed characteristics of different respiratory virus infection. Methods Retrospectively collected patients with definite etiological results using nasal and pharyngeal swabs in fever clinic. Results Totally, 1860 patients were screened and 136 patients were enrolled. 72 (52.94%) of them were diagnosed as influenza (Flu) A virus infection. 32 (23.53%) of them were diagnosed as Flu B virus infection. 18 (13.24%) and 14 (10.29%) of them were diagnosed as COVID-19 and respiratory syncytial virus (RSV) infection respectively. COVID-19 group had a higher rate of contact with epidemic area within 14 days and clustering onset than other groups. Fever was the most common symptom in these patients. The ratio of fever and the highest temperature were higher in Flu A virus infection patients than in COVID-19 patients. COVID-19 patients had lower white blood cell count and neutrophil count than Flu A virus and RSV infection group, but higher lymphocyte count than Flu A and B virus infection groups. COVID-19 group (83.33%) had higher rate of pneumonia in chest CT scan than Flu A and B virus infection groups. Conclusions Influenza viruses accounted for a large proportion of respiratory virus infection even during the epidemic of COVID-19 in Beijing. No single symptom or laboratory finding was suggestive of specific respiratory virus, however, epidemic history was important for screening of COVID-19.

which is spreading in China [1] , and influenza A H1N1, the Severe Acute Respiratory Syndrome coronavirus (SARS-CoV) and the Middle East Respiratory Syndrome coronavirus (MERS-CoV) that emerged in the past decade [2] [3] [4] . 2019-nCoV is payed much attention recently [5] , and disease caused by 2019-nCoV was named as COVID-19, short for "coronavirus disease 2019", by World Health Organization [6] .

However, other respiratory viruses, even though not that widely spreading, can also cause similar symptoms as 2019-nCoV does and should not be ignored. Here, we summarized the composition of pathogens in fever clinic patients and analyzed characteristics of different respiratory viruse infection.

Patients with fever (oral temperature >=37.3℃) or respiratory symptoms (cough, sputum, pharyngalgia, rhinorrhea, dyspnea and so on) were suggested to go to fever clinics for screening in Beijing. Peking Union Medical College Hospital (PUMCH) had a fever clinic for screening. Also, to strictly control the development of the epidemic situation of COVID-19, all patients with epidemiologic history of COVID-19 (there was a history of travel or residence in Wuhan and its surrounding areas and communities with reported cases within two weeks before the onset of the disease; or within 14 days before the onset of the disease, contacted with COVID-19 J o u r n a l P r e -p r o o f 5 patients (with positive nucleic acid test); or within 14 days before the onset of the disease, contacted with patients with fever and respiratory symptoms from Wuhan and its surrounding areas and communities with reported cases; or there was clustering onset of disease) [7] were required to screen even though without fever or respiratory symptoms at PUMCH. Clustering onset was defined as two or more cases of fever and / or respiratory symptoms were found in a small area such as family, office, school class and other places within two weeks. Patient's medical records were taken by doctors containing the symptoms, signs, epidemic history and so on. Epidemic history contained: 1) contacted with epidemic area within two weeks before the onset of the disease; 2) contacted with confirmed or suspected cases within two weeks before the onset of the disease; 3) contacted with poultry, livestock or wild animals (especially dead animals) within two weeks before the onset of the disease; 4) clustering onset. Nasal and pharyngeal swabs were collected by clinicians with 

Statistical analysis was finished by SPSS Statistics 17.0. The normality of the distribution was assessed using the Kolmogorov-Smirnov test. Group t-test was applied to the normal distribution data and Mann-Whitney U test was applied to the non-normal distribution data. Data are shown as means±SD or median(25%-75%).

Chi square test was used for comparison of two or multiple rates or components.

Analyses were presented as two-sided comparisons. The P value less than 0.05 was considered to be significant. 

Fever was the most common symptom in the respiratory virus infection patients.

All the patients of Flu A virus infection had fever, the ratio was higher than that in 

There was no statistical difference in complete blood count parameters between Similar to what was reported in COVID-19 [9] , fever was the most common symptom in the respiratory virus infection patients. In this study, the ratio of fever and the highest temperature were higher in Flu A virus infection patients than in COVID-19 patients. Given to the absence of fever and low grade fever in COVID-19 patients and its high risk [10, 11] , it was feasible to ask fever free patients with respiratory symptoms to screen as it was previously recommended [11] . Even though the rate of pharyngalgia, headache, myalgia and fatigue were relatively higher in influenza infection groups, it could not be said that presence of these symptoms was Page 10 of 18 J o u r n a l P r e -p r o o f 10 meaningful for excluding COVID-19 because they were not specific symptoms in different respiratory virus infection. Indeed, no specific symptoms were helpful in distinguishing COVID-19 from other respiratory virus infection [11] .

As it was previously reported, COVID-19 patients had low or normal WBC and neutrophil count [9, 10] . And in this study, it showed that COVID-19 patients even had lower WBC count and neutrophil count than Flu A virus and RSV infection group.

Also, it was reported that they had low lymphocyte count [9, 10] , but this study found that the lymphocyte count was higher in COVID-19 than in Flu A and B virus infection patients. This results said that low WBC, neutrophil and lymphocyte were suggestive of viral infection, but could not distinguish different respiratory virus. Also, even though CRP level was higher in RSV infection group than in COVID-19 and Flu B infection group, but it was not statistically different in Flu A infection, Flu B infection and COVID-19 groups. However, it was possible that lower WBC and lymphocyte levels and higher CRP level might be more valuable in monitoring the disease severity rather than in screening for COVID-19 [10] . The value of CBC parameters and CRP deserved more study in respiratory virus infection.

The percentage of pneumonia in Chest CT scan was higher in COVID-19 group than in Flu A and B virus infection group. It was in accordance with other studies that showed COVID-19 patients were likely to had pneumonia [9, 10] . And COVID-19 should be vigilant if it showed pneumonia in chest CT scan during the spreading of 2019-nCoV, as what was recommended in a screening procedure in fever clinic [11] .

And chest CT scan might be a fast and convenient tool in the distinguishing Ground-glass opacity

A Novel Coronavirus Emerging in China -Key Questions for Impact Assessment

Critically ill patients with 2009 influenza A(H1N1) in Mexico

Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study

A major outbreak of severe acute respiratory syndrome in Hong Kong

c2/files/b218cfeb1bc54639af227f922bf6b817.pdf

Characteristics and outcome of viral pneumonia caused by influenza and Middle East respiratory syndrome-coronavirus infections: A 4-year experience from a tertiary care center

Clinical features of patients infected with 2019 novel coronavirus in Wuhan

Clinical characteristics of 2019 novel coronavirus infection in China

Clinical features of 2019 novel coronavirus infection patients and a feasible screening procedure

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